DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Jacob Bradford	DOIID	1185662	NAIC NPN	19361868

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	1/31/2022	6/19/2023
Inactive	Non Resident	Agent	Health	1/31/2022	6/19/2023
Active	Non Resident	Staff Adjuster	Property & Casualty	7/11/2023		5/31/2026
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Staff Adjuster	03/15/2026	05/31/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Accendo Insurance Company	300312	Agent - Health	4/27/2022	1/5/2023
Inactive	Accendo Insurance Company	300312	Agent - Life	4/27/2022	1/5/2023
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	2/5/2022	3/6/2023
Inactive	Aetna Health and Life Insurance Company	300523	Agent - Health	4/27/2022	1/5/2023
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	2/5/2022	3/6/2023
Inactive	Aetna Life Insurance Company	301140	Agent - Health	2/5/2022	3/6/2023
Inactive	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/17/2022	9/29/2022
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	4/27/2022	1/5/2023
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Life	4/27/2022	1/5/2023
Inactive	Great Southern Life Insurance Company	301443	Agent - Health	2/3/2022	12/27/2022
Inactive	SilverScript Insurance Company	663526	Agent - Health	2/5/2022	3/6/2023
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	1/31/2022	12/15/2022
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	1/31/2022	12/15/2022
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	7/16/2022	9/29/2022
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	7/16/2022	9/29/2022
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	7/16/2022	9/29/2022
Inactive	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	7/10/2022	2/8/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Health Iq Insurance Services, Inc	882220	Agent - Life	2/17/2022	1/5/2023